Quality of life and symptoms of pain in patients with endometriomas compared to those with other endometriosis lesions: a cross-sectional study

Background Endometriomas are genetically distinct from other endometriosis lesions and could be associated with a predisposition to excessive inflammation. However, differences in clinical presentation between types of endometriosis lesions have not been fully elucidated. This study aimed to investigate the quality of life and pain scores of patients with endometriomas compared to those with other types of endometriosis lesions. Methods A cross-sectional observational study was conducted between January 2020 and August 2023. Patients diagnosed with endometriosis completed the Endometriosis Health Profile 30 pain subscale questionnaire for their quality of life score and rated their endometriosis-associated pain symptoms using an 11-point numerical rating scale. The data were analyzed for comparison through multivariate linear regression models. Results A total of 248 patients were included and divided into endometrioma (81, 33%) and nonendometrioma (167, 67%) groups. The mean age of the patients was 37.1 ± 7.5 years. Most participants were Canadian or North American (84%). One-third of the patients reported experiencing up to four concurrent pain symptoms. The most reported pain included deep dyspareunia (90%), chronic pelvic pain (84%) and lower back pain (81%). The mean quality of life score was 45.9 ± 25.9. We observed no difference in quality of life scores between patients with and without endometriomas. Patients with endometriomas had lower mean scores for deep dyspareunia (0.8; 95% CI [0 to 1.5]; p = 0.049) and higher mean scores for superficial dyspareunia (1.4; 95% CI [0.2 to 2.6]; p = 0.028). Comorbid infertility (p = 0.049) was a factor that modified superficial dyspareunia intensity in patients with endometriomas. Conclusion In patients with endometriosis, evidence was insufficient to conclude that the presence of endometriomas was not associated with a greater or lesser quality of life, but differences in specific symptoms of dyspareunia were identified. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-024-02919-1.

The P value for each factor was used for determining the association between the pain intensity and the presence of endometrioma (modification factor if P < 0.05; not otherwise), allowing to compare the mean difference between modification factor levels.For each level of each factor, the mean difference in the pain intensity between patients with endometriomas and those with other types of endometriosis is indicated by the blue square (point estimate value), with the 95% confidence interval delimited by the black horizontal solid line.
The vertical black dashed line represents the null value (zero) of the mean difference, indicating that the mean difference is significantly different from zero when the confidence interval does not include zero (equivalent to p < 0.05; not shown here).
The models were adjusted for age, body mass index (kg/m 2 ), ethnicity, age of menarche, parity, education level, employment status, marital status, annual income, hormone use in the last three months, and each modification factor using an interaction term with the endometriosis type variable.
Stars highlight p-values less than 0.05.Noutcomes denotes the number of patients or individuals which had the outcome in a particular group whilst Ngroup denotes the total number of people in that group."E1" denotes endometrioma group, and "E0", non-endometrioma group.
The quality of life is evaluated using the validated Endometriosis Health Profile-30 (EHP-30) questionnaire pain subscale.The EHP-30 score is categorized as impaired (score ≥ 75th centile of EHP-30 score population distribution) or best (score < 75th centile of EHP-30 score population distribution) quality of life.
The vertical black dashed line represents the null value of the odd ratios (1), indicating an odd ratio significantly different from 1 when its confidence interval does not include it (equivalent to p < 0.05).
The odds ratios are indicated by the blue squares (point estimates values) with their 95% confidence interval delimited by the black horizontal solid lines.
The models are adjusted for age, body mass index (kg/m 2 ), ethnicity, age of menarche, parity, education level, employment status, marital status, annual income, and hormone use in the last three months.

Figure S1 .
Figure S1.Subgroup analyses of mean difference in superficial dyspareunia intensity of patients with endometrioma compared to those with other types of endometriosis regarding potential modification factors.

Figure S2 .
Figure S2.Subgroup analyses of mean difference in chronic pelvic pain intensity of patients with endometrioma compared to those with other types of endometriosis regarding potential modification factors.

Figure S3 .
Figure S3.Subgroup analyses of mean difference in deep dyspareunia intensity of patients with endometrioma compared to those with other types of endometriosis regarding potential modification factors.

Figure S4 .
Figure S4.Subgroup analyses of mean difference in lower back pain intensity of patients with endometrioma compared to those with other types of endometriosis regarding potential modification factors.

Figure S5 .
Figure S5.Subgroup analyses of mean difference in dysmenorrhea intensity of patients with endometrioma compared to those with other types of endometriosis regarding potential modification factors.

Figure S6 .
Figure S6.Subgroup analyses of mean difference in dyschezia intensity of patients with endometrioma compared to those with other types of endometriosis regarding potential modification factors.

Figure S7 .
Figure S7.Impaired quality of life and severe pain symptoms of patients with endometriomas compared to those with other lesions of endometriosis.Abbreviations: OR, odd radios; CI, Confidence interval.

Table S1 .
Frequency and percentage of endometriosis subtypes in the study sample a Patients may have at least one endometriosis lesion.Endometriosis subtypes have been described separately.Values are given in frequency (percentage).